No Hope For Universal Health Care

If you are speaking of a system of medi-care like we have here in Sask., Canada, it's not the end-all and be-all you seem to think it will be. We do pay for it in higher taxes and the quality of service is deplorable. Two weeks ago, I NEEDED to see a doctor, but was unable to get any attention whatsoever. Every office I phoned was either booked, on holidays or simply not taking new patients. Thankfully my issue was not life-threatening, but nonetheless I was very frustrated with the lack of medical assistance. It is nice to have medical attention available for all regardless of financial ability but we need to make some reformations to the way our medical system carries itself everyday. Very often essential medical services are not available when we need them and we are placed on long waiting lists. a nighbor of mine recently passed away because the waiting list was too long.

At present about 40-50% of Americans who want a same day appointment with their doctors and who seem to have an urgent need for such an appointment, are able to get them on either the specified day, or the next day.

Based on personalities of most American adults, I doubt ( based on what I've seen ) that many individuals would tolerate extended wait times ( more than 4-6 months ) to see a primary care physician.

Well, you get that here 100% (if there is an urgent need for such an appointment), actually within less than an hour: there are notices in all waiting rooms of all kind of doctor that poeple shouldn't complain because urgent cases are taken first without appointment.

For not so urgent cases, you have to wait, hoping that someone doesn't look up or perhaps a couple of hours.


If it would be that only 40 - 50% got an immediate appointment - we would have a revolution here. (About 15% of doctors don't give dates at all: you just go there. [Dental surgeries: 60%.])

When you are in urgent need for an appointment, you would very likely just show up at your doctor's in Germany. About 100% of Germans are able to get an appointment within hours when in urgent need.

Access to care is available on nights and weekends, and primary care practices will make arrangements for patients to receive care when the office is closed.

Based on personalities of most German adults, I doubt (based on what I've seen) that many individuals would tolerate extended wait times (more than 1-2 days) to see a primary care physician.

I doubt that - if such would happen, namely more than one day waiting time to see a primary care physican - such practise could survive ...

Urgent care in the US is not the same as emergency care.

For instance an adult woman wakes up one morning and finds what she thinks is a lump in her breast. Is this an emergency?

Most would call this a case of urgent care and one that requires a mammogram and a visit with an internist, as soon as possible. In this case a wait of 4-6 months would not be advisable .

Neither is it in Germany. I'd think that the distinction between "urgent care" and "emergency care" was rather universal.



An emergency as in a case for the emergency room? I wouldn't say so. A case urgent enough that you want to see your physician within hours rather than days? Most certainly.



Absolutely not.

I agree.

[You get dates for a mammogram within a weeks time, if really urgent of ourse the same (or the other) day.]

As far as emergency care is concerned, unfortunately it is at the discretion of the nurses on staff. I once took my daughter in to emergency with a fever of 104. We waited for 4 hours for someone to see her. She was 5 years old at the time. Not so long ago, I took my sister-in-law to the same emergency room because she had an allergic reaction to some medication she had been prescribed. Her face was tingly and numb and her tongue was swelling. It took 3 hours for someone to see her. It's not like the emergency was busy at either of these times. There was only 3 or 3 patients ahead of us and neither of them looked any worse off than my patients were. I was rather _______off at the wait!

Universal care will happen because there is going to be a revolution in streets of America lead by middle class people like me.

Hey Miller, Go see Sicko, you'll like a lot it - I promise.

Under normal circumstances, appointments for mammograms are usually made 3-4 months in advance, so that a woman can receive one mammogram/year. If she developes a breast abnormality, she can always with the assistance of her PCP get an earlier appointment.

Time has to also be allowed, incase the annual mammogram has to be either repeated or a sonogram performed.

For the poor, free mammograms are also available.

You're going to lead a revolution? Well you just go right ahead, and when you're finished the next thing you can "correct" is shortage of MDs, that will result ( further) and the rationing of medical care.

And by the way, we already have Universla Health Care in Massachusetts and it isn't free, but it is expensive.

Welcome to the real world, where money talks.

Why do you think that universal health care would lead to

a) a shortage of MDs
b) "rationing" of medical care

??

I mean, we've been through this before, but universal health care is not necessarily the same thing as socialized health care or a single payer system. So I can't see how universal health care alone would lead to either.

Do you think that universal health care in Massachusetts has led to a shortage of MDs or rationing of medical care?

(And, quite apart from that, I agree that the kind of universal health care the Commonwealth has instituted seems to be quite expensive - with annual per capita costs twice as high as in most Western countries with universal health care.)

Funny you should mention a shortage of MD's - my very own sweet cousin, who is a heart surgeon in Michigan and married to gynocologist, have decided to move to Canada. They hate how difficult it is to deal with American insurance companies. Two of their children (twins) will attend medical school in Canada and I doubt they will come back and practice in the states. I don't get the feeling they are worried about money.

If you want to know where medical care in the US is headed, please follow some of the medical blogs now appearing on the internet, most of them authored by practicing MDs.

By the way, I'm not looking for "free" medical care, I just want to get rid of the greedy insurance companies and have everyone pay what their income allows.

So, Miller, are you going to see the movie..?

I dare you go see it Miller. As Farmerman would say - I double dog dare you.

Canadian Physicians Moving to US

In 2006, 1 in 9 Canadian-educated physicians practised in the United States. If physicians who were born in the United States are excluded, this number is reduced to 1 in 12. This accounts for just over half of the net loss of physicians from the Canadian-trained physician workforce. Collectively, this is equivalent to having 2 average-sized Canadian medical schools dedicated to producing physicians for the United States. Canada is the second largest source of immigrant physicians to the United States, second only to India.

The number of emigrant physicians approximates the current physician shortage in all Canadian provinces. In addition, graduates of Canadian medical schools who practise in the United States are more likely to choose to practise in a rural area compared to US graduates. If these physicians were to choose to stay and practise in rural Canada, this would dramatically alleviate physician shortages in rural areas of the country.22 The migration of US-trained physicians to work in Canada, only 400-500 physicians, is miniscule in comparison; this was substantiated by another recent study using similar data sources.23 Immigration of Canadian-trained physicians to the United States may be slowing, as there was a net gain in the number of physicians who returned to Canada in 2004.

Our findings are in contrast to pronouncements that emigration is not a major contributor to physician shortages in Canada.6,7 The annual net migration of Canadian-educated physicians has been sustained until recently. Although this migration has been well documented, its aggregate contribution to the physician shortage in Canada has not been.1,4 There may be many reasons that Canadian-educated physicians immigrate to the United States, and exploring these reasons will be an important step in designing policies that support the decision to stay in, or to return to, Canada. In the 1990s, there were Canada-wide and municipal policies associated with peak emigration, such as geographic and billing restrictions, but it remains unclear how these policies affected emigration trends.24 Highly specialized physicians may have a greater opportunity to develop their skills and the earning potential can also be much greater for some specialties in the United States compared with Canada. Lower taxes in the United States and rapidly rising educational debts for Canadian-educated physicians may also increase their desire to immigrate to the United States. Canadian-educated physicians may also be responding to a rigidly controlled residency training system. Whatever the reasons for physician emigration, a lack of awareness, or a lack of response, has contributed to Canada's physician shortage. In response to physician shortages in Canada, the number of spaces in publicly-funded medical schools have been increased by 15% to 30%, the first new medical school in more than 30 years has been opened,25 satellite campuses of existing medical schools have been created,26,27 the number of post-graduate positions has been increased and restrictions on international medical graduates have been loosened.28-30

There are inherent limitations of the AMA Physician Masterfile and in the cross-sectional design of our study. Because of these limitations, there is a risk of over-counting Canadian medical school graduates who train or practise in the United States and then return to Canada and a risk of undercounting physicians who have finished residency training but who are not yet counted in the physician workforce. Both the Canadian and US physician data have similar limitations in measuring migration patterns, especially for nonrespondents and in the years closest to graduation from residency training. Reliability appears to be poorest for physician data in the United States and Canada in the 3-5 years immediately after completion of residency training. Our comparisons of 2004 and 2006 AMA Physician Masterfile data suggest that this data lag may underestimate the number of Canadian-trained physicians practising in the United States by 10% or more. It also prevents a clear picture of how migration has changed for three or more years. There is also evidence of some lag time in accounting for physicians who have migrated. We believe that the evidence points to an underestimation of migration to the United States with a lag time of 5 or more years.

Our findings suggest that physician migration to the United States may be decreasing, but that efforts to further stem this loss would be beneficial. Understanding which policies would be most potent in this regard may require further study; however past research has suggested that reducing debt loads and salary differentials between Canada and the United States, using incentives to encourage physicians to practise in specific locations or providing liberal training options may help to alleviate shortages.31 Provincial governments could consider incentives to attract Canadian-educated physicians back to Canada. Encouraging migration offers some degree of control over the physician-specialty mix and policy options to stem migration risks loosening these controls. Given the cumulative loss and physicians shortages in Canada, relaxing controls on migration may be timely. Canada also benefits from the US post-graduate training system but this benefit carries risk. Of the nearly 500 graduates of Canadian medical schools who are in US residency training programs in any given year, more than two-thirds will leave the United States and presumably return to Canada. Many physicians take advantage of training in the United States that is unavailable in Canada and do so at a cost of as much as US $48 000 000 to the US Medicare program per year (the median Medicare payment per resident was US $121 169 in 2001). This training exchange benefits Canada's physician workforce, both offering and financing broader training opportunities for physicians. However, Canadian-educated physicians who complete their residency training in the United States are less likely to return to Canada and are as much as 9 times more likely than Canadian-educated physicians who completed their residency training in Canada to later immigrate to the United States.31 It may be desirable to respect this risk and permit the exchange, but to create incentives for returning to Canada.

The United States is a major beneficiary of the Canadian medical education system, and Canada is a beneficiary of US post-graduate training programs. These trade-offs may represent a mutually beneficial exchange that is not typical of most physician-donor nations. Canada and other developed countries could promote these beneficial exchanges while avoiding the "pillage" of physicians from developing countri

http://www.cmaj.ca/cgi/content/full/176/8/1083